Antiemetic Efficacy of Prophylactic Ondansetron in Gynecologic Patient Using Patient-Controlled Analgesia after Surgery / 대한마취과학회지

BACKGROUND: Postoperative nausea and vomiting remain troublesome problems, especially in women receiving the opioid analgesics. This study was performed to assess the antiemetic efficacy of ondansetron in patients using an intravenous patient-controlled analgesia (IV-PCA) after gynecologic surgery. METHODS: In this randomized placebo-controlled study, forty healthy gynecologic surgical patients received ondansetron 4 mg or placebo at the end of surgery. Patients in the recovery room received fentanyl by PCA which provided a bolus dose of 20 microgram, a lockout time of 6 minutes, and a basal infusion of 20 microgram/hr. We assessed the occurrence of nausea, vomiting, and the need for rescue antiemetics during the first 24 hours after operation. RESULTS: During the first 24 hr after operation, 40% of patients experienced no nausea or vomiting in the ondansetron group compared to 30% of patients in the placebo group. There was no significant difference in the incidence of nausea between groups (70% in placebo group vs 60% in ondansetron group). However, ondansetron reduced the incidence of vomiting from 50% to 15%, and the need for rescue antiemetics significantly from 25% to 0% (P< 0.05). CONCLUSIONS: Ondansetron in a dose of 4 mg does not prevent postoperative nausea during the first 24 hours after operation when used with fetanyl PCA. However, ondansetron significantly reduces the chance of postoperative vomiting and rescue antiemetics.

Comparison of Epidural Patient-Controlled Analgesia and Intravenous Patient-Contolled Analgesia for Pain Relief after Cesarean Delivery / 대한마취과학회지

BACKGROUND: Epidural administration of local anesthetics and opiate or intravenous administration of opiate and ketorolac has proven to be effective in the treatment of postoperative pain. Studies that compare epidual morphine-bupivacaine vs intravenous nalbuphine-ketorolac administration showed conflicting results. We compared the ability and side effects of epidural (EPI-PCA) morphine-bupivacaine versus intravenous (IV-PCA) nalbuphine-ketorolac for postoperative pain relief after cesarean delivery. METHOD: Sixty healthy women were randomly assigned to receive an epidural bolus of morphine 3 mg mixed with 0.5% bupivacaine 10 ml, followed by a EPI-PCA with 0.0125% morphine and 0.125% bupivacaine (basal infusion 2 ml/hr, bolus 0.5 ml, lock-out interval 15 min) or intravenous bolus of nalbuphine 5 mg, followed by a IV-PCA with 0.05% nalbuphine and 0.15% ketorolac (basal infusion 2 ml/hr, bolus 0.5 ml, lock-out interval 30 min) for pain relief after cesarean delivery. The intensity of pain was assessed by the patient, who was unawared of the dose given, using a visual analog scale (VAS). To compare intensity of pain, VAS was used at 1, 6, 12, 24 and 40 hour after the end of surgery. RESULT : EPI-PCA group had significant lower visual analog scale (VAS) at immediate postoperative period, whereas no significant difference was observed when pain was assessed at other time sequence. Pruritus was more frequent with EPI-PCA group, although the incidence of other side effects were the same. CONCLUSION: We conclude that EPI-PCA or IV-PCA using morphine-bupivacaine or nalbuphine- ketorolac is relatively effective and safe method for the postoperative pain control. Although EPI-PCA with morphine-bupivacaine shows lower VAS at immediate postoperative period, IV-PCA with nalbuphine-ketorolac is a safe and effective alternative to EPI-PCA with morphine-bupivacaine for providing pain relief after cesarean delivery.

The Preemptive Analgesic Effect of Intravenous Ketamine / 대한마취과학회지

BACKGROUND: Preemptive treatment with ketamine, a noncompetitive NMDA antagonist, may prevent establishment of postoperative hypersensitivity by blocking the sensory input that induces the central sensitization. The aim of this study was to determine if continuous preemptive administration of intravenous (IV) ketamine decreases postoperative pain. METHODS: Sixty healthy informed patients scheduled for elective abdominal hysterectomy were randomly divided into two groups of equal size and studied in a double-blind manner. Before surgical incision, patients were given 1 mg/kg of ketamine or equal volume of saline followed by IV infusion of 0.01 mg/kg/min, which was discontinued at peritoneal closure. IV morphine patient-controlled analgesia (PCA) was started in all patients at peritoneal closure. Visual analogue scale (VAS) pain scores and total morphine consumption were recorded at 1, 3, 6, 9, 12, 24, 36, and 48 hours postoperatively. RESULTS: VAS pain scores at rest were significantly less in the ketamine group than in the saline group at 1, 3, 24, 36, and 48 hr postoperatively. VAS at moving status were less in the ketamine group at 1, 3, 12, 24, 36, 48 hr postoperatively. Patients in the ketamine group had significantly lower morphine consumption throughout the study period, about 20-50% reduction in postoperative total morphine was observed. Only ketamine group experienced severe headache (10 cases), while there were no intergroup differences in other side effects such as pruritus, bad dream, and backache. CONCLUSION: These results suggest that preemptive continuous IV ketamine decreases postoperative pain intensity and IV morphine requirement, and its action lasts longer than the normal expected duration of action of ketamine.

The Effects of Stomach Cancer Surgery on Immunomodulation and Neuroendocrine Response: Comparison of Anesthesia and Analgesia Methods / 대한마취과학회지

BACKGROUND: Authors have undertaken this study to see if the choice of anesthesia can directly or indirectly provide immunomodulation for cytokines, to determine the relationship of cytokines and hypothalamo-pituitary-adrenal axis in stomach cancer surgery patients, and also to see whether the amount of morphine administration and choice of analgesia can influence cytokine release, and possibly immunity. METHODS: Total 19 gastric cancer surgery patients were randomly assigned in double-blind fashion into two groups. Group-G (n=9) was provided with general anesthesia plus morphine intravenous patient controlled analgesia (IV-PCA), whereas group-GE (n=10) with preemptive epidural and general anesthesia plus continuous epidural analgesia for control of postoperative pain. At predetermined time interval, proinflammatory cytokines and stress hormones were evaluated with visual analog pain scale. Simultaneous assessments of operating and anesthesia time, total morphine doses, the time to recovery of gastrointestinal function and incidences of complications were also made. RESULTS: Demographic data, the durations of operation and anesthesia and recovery of gastrointestinal function were similar in both groups. Total morphine doses were approximately four times greater in group-G. Secretions of interleukin-1 beta , TNF and epinephrine were blocked by preemptive epidural anesthesia, meanwhile, interleukin-6 as well as ACTH and cortisol were not. After 24 hours after skin incision, the differences of cytokines, ACTH and cortisol between two groups were dissipated. In spite of these hormonal findings, visual analog pain scale could not disclose any differences. Incidences of complications were statistically insignificant except that of itching in group-GE. CONCLUSION: Preemptive epidural anesthesia and analgesia can partially block only some of cytokines and stress hormones, and these effects do not have clinically relevant long term influences. The amounts and means of morphine administered by continuous epidural analgesia block or IV-PCA demonstrated no evidence of immunosuppression at clinical dose range.

Efficacy of Patient-Controlled Epidural Analgesia according to Changes of Continuous Background Infusion Volume / 대한마취과학회지

BACKGROUND: This study examined the efficacy of patient-controlled epidural analgesia (PCEA) for post-cesarean section pain control and compared the suitability of four different volumes of continuous background infusion (CBI). METHODS: Sixty patients were received 0.125% bupivacaine with 5 g/ml fentanyl by PCEA (2 ml of demand dose and 10 minutes of lockout interval) and CBI. Experimental groups were divided four groups according to the volumes of CBI; 1 ml/hr, 2 ml.hr, 3 ml/hr and 4 ml/hr of CBI during 48 hours postoperatively. RESULTS: Total amount of fentanyl and bupivacaine consumption was significantly higher in 1ml/hr of CBI group than 2 ml/hr of CBI group during first 24 hours, and in 4 ml/hr of CBI group than 1 ml/hr and 3 ml/hr of CBI group during second 24 hours. CBI/maximum hourly demand dose was 15~23%. There is no significant difference between the groups in pain score, side effects and patient's satisfaction. CONCLUSIONS: This study suggests that two or three ml/hr of CBI can provide the most effective postoperative analgesia and the optimal ratio of CBI/maximum hourly demand dose is about 20%.